Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative
Reduction of severe maternal morbidity from hemorrhage using a state perinatal quality collaborative
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DOI：
10.1016/j.ajog.2017.01.017
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发表时间：
2017-03-01
影响因子：
9.8
通讯作者：
Gould, Jeffrey B.
中科院分区：
文献类型：
--
作者：
Main, Elliott K.;Cape, Valerie;Gould, Jeffrey B.
背景：产科出血是美国严重孕产妇发病和可预防孕产妇死亡的主要原因。加州孕产妇质量护理合作组织根据国家产科出血患者安全包开发了一套针对出血的综合质量改进工具包，并在试点实施项目中取得了可喜的成果。 目的：我们试图确定这些安全工具是否可以通过大型孕产妇质量合作组织扩大规模，以降低产科出血妇女的严重孕产妇发病率。 研究设计：我们报告了 99 家合作医院（每年出生 256,541 名新生儿），使用使用 48 家非合作比较医院（每年出生 81,089 名）的前后模型来检测任何系统性趋势。两个小组都参加了加州孕产妇数据中心，提供基线和快速周期数据。基线期为2011年1月至2014年12月的48个月。合作于2015年1月开始，干预后期为2015年10月至2016年3月的6个月。我们修改了医疗保健改善研究所合作模式，以实现突破性改进，纳入导师模式，由20对在质量改进方面经验丰富的护士和医生导师为6-8家医院的小组提供额外支持。国家出血安全捆绑包作为质量改进行动的模板。主要结果测量是疾病控制和预防中心针对出血妇女目标人群和总体分娩人群的严重孕产妇发病率综合测量。束要素的采用率被用作医院参与度和强度的指标。 结果：与基线期相比，合作医院的出血妇女的严重孕产妇发病率降低了 20.8%，而对比医院的妇女则降低了 1.2%（P
BACKGROUND: Obstetric hemorrhage is the leading cause of severe maternal morbidity and of preventable maternal mortality in the United States. The California Maternal Quality Care Collaborative developed a comprehensive quality improvement tool kit for hemorrhage based on the national patient safety bundle for obstetric hemorrhage and noted promising results in pilot implementation projects.OBJECTIVE: We sought to determine whether these safety tools can be scaled up to reduce severe maternal morbidity in women with obstetric hemorrhage using a large maternal quality collaborative.STUDY DESIGN: We report on 99 collaborative hospitals (256,541 annual births) using a before-and-after model with 48 noncollaborative comparison hospitals (81,089 annual births) used to detect any systemic trends. Both groups participated in the California Maternal Data Center providing baseline and rapid-cycle data. Baseline period was the 48 months from January 2011 through December 2014. The collaborative started in January 2015 and the postintervention period was the 6 months from October 2015 through March 2016. We modified the Institute for Healthcare Improvement collaborative model for achieving breakthrough improvement to include the mentor model whereby 20 pairs of nurse and physician mentors experienced in quality improvement gave additional support to small groups of 6-8 hospitals. The national hemorrhage safety bundle served as the template for quality improvement action. The main outcome measurement was the composite Centers for Disease Control and Prevention severe maternal morbidity measure, for both the target population of women with hemorrhage and the overall delivery population. The rate of adoption of bundle elements was used as an indicator of hospital engagement and intensity.RESULTS: Compared to baseline period, women with hemorrhage in collaborative hospitals experienced a 20.8% reduction in severe maternal morbidity while women in comparison hospitals had a 1.2% reduction (P